The document discusses trauma-informed care as a crucial movement in healthcare aimed at addressing the effects of abuse and chronic illness linked to adverse childhood experiences (ACEs). It highlights the importance of recognizing the impact of trauma on patients and healthcare providers, promoting methods to create safe and supportive environments through ongoing training and community engagement. The document also references various national and international initiatives that aim to reform care and enhance responses to trauma across multiple sectors.

1. TRAUMA-INFORMED CARE A
NATIONAL HEALTHCARE MOVEMENT
Treating the Hidden Epidemic of Abuse,
Violence & Chronic Illness

2. The Hidden Epidemic – ACEs

3. The Hidden Epidemic – ACEs

4. The Hidden Epidemic – ACEs

5. It is not all in your head…
Picard, M. et al. (2014) Mitochondrial allostatic load puts the ‘gluc’ back in glucocorticoids
Nat. Rev. Endocrinol. doi:10.1038/nrendo.2014.22

6. Clinical Review – The Human Impact
¨ Trauma exposer increases the
incident of paradoxical and
complex reactions to medications.
¨ DM-II: Hypothalmic-pituitary-
adrenal activity is enhanced in
patients DM-II related
complications and the degree of
cortisol relates to presence and
number of diabetes complications.
Journal Diabetes Care - Cortisol Secretion in Patients With Type 2 Diabetes - doi:
10.2337/dc06-1267
¨ Clinical Case – Discussion

7. Pathways of Care - 3 Core Impacts +1
¨ PTSD Treatment
Addressing Impact of PTSD
and Acute Stress Reactions
¨ Trauma Informed Care
Addressing sub-syndromal
impacts of high stress and
adverse events
¨ Trauma Informed Disease
Management
Impact of Stress and
Dysregulation on Health
Conditions
¨ +1 - Providers are People First
Impact of Patient Trauma on
Treatment Providers

8. Human Interaction - The Heart of the Mater
From Disconnection to Connection
¨ Neuroception: Sub-conscious threat detection system. Simple
behaviors can indicate safety.
¤ Stanford’s Compassion Care Conference
Link: https://www.youtube.com/watch?v=MYXa_BX2cE8
¨ Serve and Return: The Basic Human Pattern of Relationship
¤ Harvard’s Center for Developing Child
Link: https://www.youtube.com/watch?v=bF3j5UVCSCA
¨ Still Face Experiments:
¤ Threat and Disconnection
¤ What Happens When Serve and Return Brakes Down.
¤ Ed Tronic’s work on Human Connection – PCPs
https://www.youtube.com/watch?v=apzXGEbZht0

9. Notice How You Feel When You See…

10. Notice How You Feel When You See…

11. 7 Core Domains: Trauma Informed Care
Early Screening and Assessment
Consumer-Driven Care and Services
Trauma Responsive Work Force
Evidenced Based & Emerging Best Practices
Community Out-Reach - Building Community Partners
Trauma Safe Work Environments
Ongoing Training, Performance Improvement & Eval
Link on TIC
http://
www.samhs
a.gov/nctic

12. Trauma Informed Care
National and International Movements
¨ Harvard’s Project 1 Billion
Link to Site: http://hprt-cambridge.org/project-1-billion-2/
¨ 2013 Iowa Adverse Childhood Experiences Summit
Link to Speakers: http://www.iowaaces360.org/iowa-aces-summit.html
¨ California’s first ACEs summit: Children Can Thrive (2015)
A three-day summit on Adverse Childhood Experiences, or ACEs, strengthens California’s efforts to orient policy
and practice around preventing and responding to child trauma.
Link to Article: http://acestoohigh.com/2014/11/20/children-can-thrive/
¨ National Summit on Adverse Childhood Experiences (2013/14)
Purpose: Bring together national and local leaders committed to understanding the research, policy and
practice implications about adverse childhood experiences (ACEs) in order to create a paradigm shift within
healthcare, mental health, and child-serving systems.
Link to Page: http://instituteforsafefamilies.org/events/national-summit-adverse-childhood-experiences
¨ ACEs Connection Network: ACEs Connection is a social network that accelerates the global movement toward
recognizing the impact of adverse childhood experiences in shaping adult behavior and health, and reforming
all communities and institutions -- from schools to prisons to hospitals and churches -- to help heal and develop
resilience rather than to continue to traumatize already traumatized people.
Link to Site: http://www.acesconnection.com/
Link to Sonoma ACEs Connection: http://www.acesconnection.com/g/sonoma-county-aces-connection
Link to Contra Costa County Aces Connection:
http://www.acesconnection.com/blog/contra-costa-county-to-end-isolation-of-special-ed-students-in-juvenile-
hall-edsource-org

13. Stress and the Front Brain
Stress Shuts Down
Frontal Lobe
Function
When the frontal
lobe is shut down
you are speaking
to pure
emotion or
at times even
reptilian systems

14. Homeostasis and Dysregulation

15. Clinical Tools – Treatment Relationships
¨ Bruce Perry’s “4 Steps”
¤ Regulate Self – When we are stressed we have
non-verbal cues that indicate to those we are around we are
stressed. Individuals exposed to trauma have a heightened
sensitivity to these cues (Facial Expression of Emotion Studies).
¤ Regulate Other – Actively help your patient regulate. Use a stress
reduction tool, distraction technique or simply become more
interesting then their stress.
¤ Attune – Engage the ‘Serve and Return’ style. When people feel
seen, heard and understood they shift from stress to rest.
¤ Reason – Once some one is regulated they are more available to
reason. Signs of regulation are good eye contact, taking a deep
breath, borboygmi, expression of curiosity (indicates frontal lobe is
working again).
Clinical Story – Proximity and Stress

16. PACE Attitude – Quality of Contact
¨ Playfulness – A willingness to laugh, joke and play even in difficult
situations. Pulls an individual out of fight flight into frontal lobe and
limbic connection.
¨ Acceptance – Acceptance builds a context of safety and connection.
Accepting is not agreeing or supporting but just recognizing reality
when it is present.
¨ Curiosity – Curiosity is the hallmark of social engagement. This pulls
an individual out of fear or anger states and into the state where
new possibilities can arise. It begins to support decreased stress
reaction and increase parasympathetic tone.
¨ Empathy – The experience of being understood develops the ability
to care for one’s self. Creates a context of safety and
understanding. This allows for an individuals guard to go down and
the shift into more curiosity and possibility.

17. Trauma Informed
Approach Impact in Treatment
CASE REVIEW AND DISCUSSION

18. Role Play: Trauma Informed Care
Using tools discussed practice a clinical interaction.
PACE Attitude
4 Steps
Instructions for Dyads